Double switch operation showed similar 5-year transplant-free survival (93% vs 75%, p=0.939) but higher LV dysfunction (17.7% vs 2.8%) and pacemaker need (19% vs 6.5%).
Does double switch operation improve transplant-free survival compared to physiological or no repair in patients with congenitally corrected transposition of the great arteries?
Double switch operation for congenitally corrected transposition of the great arteries does not significantly improve 5-year transplant-free survival compared to physiological or no repair, and is associated with higher risks of LV dysfunction and pacemaker implantation.
Abstract Background Congenitally corrected transposition of the great arteries is a rare condition which can be detected late in life due to heart failure and arrhythmia. Failure of the systemic RV is the most common cause of death with limited pharmacologic strategies for remodelling. Double-switch repair offers the opportunity for a systemic left ventricle with training for systemic pressure and may improve long-term survival. Surgical experience is limited. Aims We sought to systemically review literature to evaluate outcomes of patients undergoing double switch repair with other forms of anatomical repair Methods A systematic literature review was conducted according to the PRISMA guidelines using the databases PubMed, Cochrane Central Register of Controlled Trials, Scopus and Medline (2000-2024; English only). Out of the 44 total studies screened, a total of 22 peer-reviewed articles fulfilled the criteria for inclusion. A total of 1398 patients were included in our meta-analysis, 516 of whom had double switch operation and 865 patients with a biventricular circulation who had either no repair or repair of associated lesions. Demographic data, peri-procedural outcomes and long-term survival, re-intervention and pacing rates were collated as pooled data. Results Patients with DSO were younger (mean age DSO 3.5 years/non-DSO 6.5 years, p=0.008), had a lower weight at time of operation (DSO 10.9 kg/non-DSO 16.5 kg), and more likely to have pre-operative tricuspid regurgitation. Post-operatively, LV dysfunction was more prevalent in the DSO group (17.7% DSO vs. 2.8% non-DSO, p0.001), more likely to have reoperation on neo aortic valve (10.5% DSO vs 0.78% non-DSO), and more likely to require permanent pacing (19% DSO vs 6.5% non-DSO, p=0.005 ). There were no statistically significant differences in groups in heterotaxy (3% DSO vs 4% non-DSO, p=0.7), postprocedural mortality (13.5% DSO vs 16% non-DSO, p=0.726) and transplant free survival at 5 years (93% DSO vs 75% non-DSO, p=0.939). Conclusion There were no significant differences in 5-year transplant free survival or in re-intervention rates among patients who underwent DSO compared to those who had physiological or no repair. Risk of LV dysfunction was higher as was risk of pacemaker implantation. DSO is a viable short-term option in patients with complicated anatomy or valvular disease, however longer-term follow up into adulthood is important.Graphical abstract
Mishra et al. (2025) studied this question. Double switch operation showed similar 5-year transplant-free survival (93% vs 75%, p=0.939) but higher LV dysfunction (17.7% vs 2.8%) and pacemaker need (19% vs 6.5%).